Article excerpt

Health screening and early detection of cancer results in significantly better health outcomes and lower mortality (Australian Institute of Health and Welfare [AIHW] 2007a, 2007b). Most deaths due to cervical and breast cancer are avoidable due to screening, early detection and timely treatment. Despite this, in recent years participation rates in some national screening programs have decreased (AIHW, 2007b).

New South Wales (NSW) has the lowest percentage of all states in Australia for participation in the National Cervical Screening Program despite having the highest number of new cases and deaths from cervical cancer (AIHW, 2007b). More specifically, the regional area targeted for this study has notably lower participation rates for breast and cervical cancer screening than NSW as a whole (Sydney South West Area Health Service [SSWAHS], 2005).

The regional area targeted for the purpose of this study is considerably more socioeconomically disadvantaged than most other areas in NSW, with high unemployment and a high proportion of welfare-dependent families (Australian Bureau of Statistics [ABS], 2006a, 2006b; SSWAHS, 2005). Furthermore, this regional area is ethnically diverse with around half of the population being immigrants, and only 40% speaking English at home (ABS, 2006a).

Additional social disadvantage in this area is evidenced by statistics that show that people with disabilities in this regional area account for almost 16% of the population (ABS, 2006a). Also Indigenous people, who have a greater incidence of cancers and poorer outcomes than non- Indigenous people (Reath & Carey, 2008), account for around 1% of the total population for the regional area (ABS, 2006a). Further, there were 334 sexual assaults reported in 2007 for this disadvantaged regional area (not including indecent assaults, acts of indecency and other sexual offences which accounted for an additional 370 cases; Goh & Moffatt, 2008). However, as not all sex crimes are reported, actual figures for these assaults may be much higher.

This paper stems from a broader qualitative study that recruited women's healthcare workers and women's health consumers from the abovementioned regional area for the purpose of exploring their perceptions and attitudes to women's health screening. A previous publication from this study (Peters, 2010) highlighted women's preferences regarding the type of service they can access for women's health screening. This current paper explores the accounts of women's healthcare workers and consumers of women's health screening to illuminate perceived barriers to such services for women from minority cultural groups, those who have physical disabilities, and women who have been sexually abused. Whilst it is acknowledged that women's health screening services can incorporate screening for an extensive amount of conditions/diseases, this study refers to cervical screening (Papanicolaou [pap] tests) and mammography due to the emphasis participants placed on these procedures throughout their narratives.

LITERATURE REVIEW

Previous studies (for example see Chevarley et al., 2006, and Smeltzer, 2006) have identified that women with disabilities are less likely than able-bodied women to access health screening. Additionally, women with disabilities have been found to have a higher mortality rate due to breast cancer and are often diagnosed at a more advanced stage than able-bodied women (McCarthy et al. …